Referral management and network leakage reduction were already top-of-mind issues for providers, and thanks to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), they will now be even more critical.
MACRA introduces new formulas to determine physicians’ Medicare Part B payments based on how they perform relative to other providers. Implementation of these performance-based payments will be phased in over the next few years, beginning with data collection in 2017 and at-risk payments in 2019. Referral management will play a key role in determining providers’ success under MACRA, influencing their performance on numerous measures. In addition, several of the new measures for determining physician payments will specifically track how providers manage referrals.